Does it take time from breast implants to drop if placed above muscle & under fascia?

Question

Also do you lose CCs when going under the muscle as opposed to over? (do they appear bigger over the muscle)

Steven Sigalove, MD FACS · Answer

Regardless of whether your implants are subfascial or dual plane, there is always settling of the implant and the pocket. Following subfascial breast augmentation, there will be less (craziness) in the upper pole compared to dual plane typically. Post operatively, subfascial breast augmentations tend to look more true to the final result than dual planes do, but even they will be settle and the upper poles will be less full due to postop stretch and settling of the soft tissues. This is a natural response following surgery and so it is important understand that no matter where the implants are placed intraoperatively, the implants will ALWAYS settle and drop to a degree. Gravity wins in the end no matter what.

Semih Yildiz, MD, FEBOPRAS · Answer

Implants placed above the muscle and under the fascia can still settle, but the change is often less dramatic and sometimes faster than submuscular implants. “Dropping” usually reflects swelling going down, the pocket relaxing, and the lower breast skin stretching enough for the implant to sit naturally.

You do not lose CCs by placing the implant under the muscle; the implant volume is the same. It may appear a little less projected or slightly more compressed early on because the muscle and soft tissue cover part of the implant. Over-the-muscle implants can look more obvious or larger because they sit closer to the skin, but that can also mean more visibility, rippling, or edge show in thin patients. The best plane depends on your tissue thickness, breast shape, implant choice, and the look you want.

Brian K. Reedy, MD · Answer

Thanks for your question!
It can take 6 months for the implants to drop and settle into position. Continue to follow your post op instructions and contact your surgeon with any concerns. Best wishes

Jeffrey Lisiecki, MD · Answer

Subfascial breast implants do settle a little bit with time, but they not have the same exaggerated "drop and fluff" process that implants under the muscle do, which is one of the benefits of this technique.  Some think they appear bigger over the muscle than over, but how much that difference in appearance is depends on how large the implants are relative to your muscle, breast tissue, frame, etc.

Daniel Barrett, MD · Answer

Dear Khloe14109,
in most cases, surgeons will recommend patients to wait 6 months after surgery to see the final results. I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Gerald Minniti, MD, FACS · Answer

What matters little is the healing process. What matters far more is long term good results with the least risk of reoperation. If you do that, then the data points to subpectoral implant placement. Subfascial implant placement has not been demonstrated to have as low a capsular contracture rate as subpectoral placement.  Implant selection to achieve your goal appearance is easy for an experienced surgeon who uses either sizers in the office (preoperatively, not intraoperatively), which is my prefered method, or 3D photo simulation.

John Michael Thomassen, MD · Answer

As long as the inframamamry fold is not violated, the implants should not drop more significantly in one plane vs the other.  Submuscular placement may have the implants appear a bit more flat at the beginning but after a few weeks they regain their normal shape.

Connie Hiers, MD, FACS · Answer

There is less dropping when the implants are not placed behind the muscle. The volume is still present, whether the implants are in front of or behind the muscle. However, behind the muscle gives more compression on the implant when flexed, but does give nice upper breast fullness.

Camille Cash, MD · Answer

Implants placed under the muscle may appear slightly smaller than those placed subglandularly.  Going under the muscle does provide a few extra benefits.  The muscle disguises the upper portion of the implant which is especially helpful in those who are thin or have little natural breast tissue.  They also carry a lower risk of capsular contracture.  This placement is typically the choice of patients who are looking for a more natural look.

Does it take time from breast implants to drop if placed above muscle & under fascia?

Answers (9)

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